The Effect of an Educating versus Normalizing Approach on Treatment Motivation in Patients Presenting with Delusions: An Experimental Investigation with Analogue Patients
Until recently a widespread recommendation for clinicians was not to respond to the content of patients' delusions but to stress at an early time point that the patient has a mental illness (educating approach). An opposed recommendation is to validate the patients’ symptoms and normalize them (normalizing approach). This study used an experimental design to compare the impact of these two approaches on treatment motivation (TM). A cover story about a person who develops persecutory delusions was used to guide a sample of 81 healthy participants who served as analogue patients into imagining experiencing delusions. This was followed by a random assignment to either an educating or a normalizing consultation with a fictive clinician. Consultations only differed in content. Finally, we assessed the participants' motivation to accept medication (Medication TM), psychological treatment (Psychological TM), and treatment offered by this particular clinician independent of the kind of treatment (Clinician-related TM). Participants in the normalizing condition showed higher Clinician-related and Psychological TM than those in the educating condition. Medication TM was unaffected by condition. Following our results using a normalizing approach seems to be advisable in a first-contact situation with patients with delusions and favourable to a simple educating approach. 1. Introduction Communication with the patient is a central feature of mental health treatment. In treating delusions, the question of what constitutes a “good communication style” is controversial. There seems to be a considerable gap between patients’ and clinicians’ perspectives of good communication in the consultation. Many patients actively attempt to talk about their delusional beliefs [1] and expect the clinician to listen and respond to their problems [2]. This expectation stands in contrast to clinical practice. Through analysing conversations in routine psychiatrist-patient consultations, McCabe et al. [1] found that psychiatrists avoid responding to the patients’ concerns and rather evade their questions. Van Meer [3] confirmed that many psychiatrists were traditionally trained not to respond to delusional beliefs. Although today the idea of discussing the content of patients’ beliefs is somewhat more widespread, many clinicians still fear that responding to delusional beliefs in an empathic manner or discussing them will make them worse [4]. Consequently, clinicians try to communicate that the delusional belief is a symptom of a mental disorder. This so-called “doctor-knows-best”
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